OCD can make people worry about doing the most shameful things.

My Patient Fears He’s a Pedophile

“I have an inpatient who worries that he might be a pedophile,” the psychiatrist said. “I think it’s OCD, but he has a young daughter and our social worker wonders if we should make a report to children’s services.“ This was when I first heard about “John,” as we’ll call him. A psychiatrist at a local hospital contacted me because he wanted to consult about their latest admission. The treatment team was divided on his diagnosis and what the next steps should be.

John was a devout Christian, tormented by unrelenting thoughts that he was really a child molester – a ticking bomb just waiting to go off and cause harm to his young daughter, her friends, and any children he might get his hands on. These terrifying thoughts became so upsetting that John fell into a deep depression, finally contemplating suicide as the only way to keep his daughter safe. That was when his family took him to the ER.

Because I study and treat some of the lesser-known manifestations of OCD, I am frequently in touch with patients, family members, and other mental health professionals who are trying to make sense out of thoughts that just don’t make sense. Why would a good person who loves his family agonize over such ugly thoughts if he didn’t have something to hide?

The Obsessive-Compulsive Cycle

This is the paradox of OCD. It takes the very thing a person cares the most about and turns it upside-down. Most people know of OCD as that illness that makes people was their hands over and over, or they mistake OCD for that quirky personality trait that drives perfectionists to color code their files and line up cans in the pantry. OCD is much broader and more debilitating than most realize. Symptoms typically fall under one of four categories: contamination/cleaning, doubt/checking, symmetry/ordering, and unacceptable/taboo thoughts. Within the category of unacceptable/taboo thoughts are included the sexual obsessions and their related compulsions. People with this sort of OCD may worry that they will become gay, commit rape, or cheat on their partners, but of all the forms that OCD may take, I am convinced that worry about becoming a pedophile is the worst.

POCD can be hard to face.

As the name implies, people with OCD have obsessions and compulsions. Obsessions are worries and fears that keep coming back. Compulsions are ritual-like behaviors the person with OCD does again and again to ensure the safety of themselves or others. When someone worries about getting ill from germs (obsession), they may wash repeatedly (compulsion). But what does a person do who worries about molesting a child? John did his best to avoid his daughter and other children, especially when no one else was around. He said repeated prayers and compulsively read the Bible. He kept asking his wife and pastor for reassurance that he was really a good person. He repeatedly conjured up mental images of children to make sure he wasn’t sexually aroused by them. These rituals made him feel better until the worries returned, and then he would start all over. The interval during which John felt better got shorter and shorter. The worries had become nearly constant and the compulsions were now taking up his whole day.

People with Pedophile OCD are not Pedophiles

“Whatever you do, don’t make a report until I have a chance to asses the patient,” I told the psychiatrist. I knew that if John had OCD, it was very likely that his form of the disorder would not be quickly understood by authorities, potentially resulting a stressful quagmire of legal issues surrounding his ability to be a parent. That sort of added stress would be very thing that might drive an already fragile person over the edge. It is true that John was in no shape to function in any capacity, much less as a father. He had been demoted at work due to his condition, as he was frequently distracted, or he would call in sick due to depression. However, people with pedophile OCD (or POCD, as it is sometimes called in the online OCD communities), are actually the least likely to harm a child. In fact, John cared so much about the well-being of his daughter that he was willing to kill himself to keep her safe.

After John was discharged, I conducted a comprehensive assessment of his symptoms. He had been diagnosed with OCD at age 12. He used to worry about religious and spiritual matters, like if he was going to heaven after he died, but as he got older his worries shifted into other areas. He once feared that he might be attracted to his sister, then that he might be gay, and most recently that he might be a pedophile.

Treatment for Pedophile OCD

It’s important to understand that John was never attracted to children (nor men, nor his sister). OCD is a malfunction in the brain that causes catastrophic worries about things that are very unlikely to occur. Although largely genetic, OCD can be treated behaviorally. I treated John with a specialized form of cognitive-behavioral therapy (CBT) called Exposure and Ritual Prevention (Ex/RP). We used the 17-session protocol developed by Dr. Edna Foa and other clinical researchers at the University of Pennsylvania, where I had treated some of the most severe cases before relocating to the Center for Mental Health Disparities at the University of Louisville. Research has shown that other types of therapy, like traditional “talk therapy” or psychoanalysis, are not helpful for OCD.

The first thing I did was to teach John how to identity and distinguish between obsessions and compulsions. He was instructed to uncritically accept all obsessions, but to resist all compulsions. Compulsions are the driving engine for OCD, so by halting them, the disorder starts to weaken its grip. We also conducted behavioral exposures, focused on doing the things John had been avoiding. Initial exposures were as simple as having John look at pictures of children without ritualizing. It was a slow start, and John cried throughout our first three sessions. He would sometimes call my cell phone in a panic when something triggered his worries, but over time his ability to tolerate anxiety increased. As we moved to up the hierarchy to bigger things, John began spending time with children and taking his daughter to swimming lessons. By the end of the treatment program, he was feeling tremendously better. Although there is no 100% cure for OCD, John became convinced he was not a pedophile.

One Patient’s Act of Bravery

I am always amazed by how quickly this treatment can help people get their lives back, which is one of the reasons I love working with people who have OCD. John was able to resume his normal life after just 17 sessions. In fact, he remains so grateful and excited about his recovery that he was willing to share his experience on a local TV show, The Power to Change. I was in the studio audience when the episode was recorded, and several of my close colleagues were expert guests on the show. One of the reasons the public knows so little about POCD is because people are afraid and ashamed by it. By putting his story out there for others to hear, I believe John’s act of bravery will make an incredible difference in the lives of many.

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Actually, the patient was medicated.
He did well with the Ex/RP treatment, as would be expected, given his diagnosis of OCD. If he was in fact psychotic or bipolar, we would have seen a very different outcome.
Best regards,
Dr. Williams

Thank you for this article, I have stuggled with this OCD since I was 13 years old. I went down here again this year and I'm now seeing a consoler. It has been working and I'm going to be discharge soon. But I would like to talk to someone who specialized in this OCD. I have many questions and I'm trying my best to get on with my life. I'm 17 years old and it's really hard sometimes. If you have any advice please reply. Thank you

I was very interested on your thoughts of pocd. I've been struggling with ocd since I was a young child, 27 now, and am having really intense thoughts. Do you have any suggestions on how what I should do to treat my obsessions? I feel like I can't be around kids anymore and am uncomfortable when i am. Thanks

It honestly astounds me that you seem to think you know more about these things than a trained professional, unless you also studied these subjects extensively and are trained to diagnose.

In everything I've read on mental health websites written by professionals and everything I've been told by mental health specialists, they don't say anything about it being related to the things you have listed above.

So I'm curious, are you actually a trained professional? Or are you just another person who seems to think that because they've read a few articles, they're an expert on these subjects?

Dr. Williams, Thank you for this wonderful article which sheds light on how devastating OCD can be. You are so right that OCD preys on the things that matter most to a person. Also, if "John" had actually been a pedophile, then his thoughts would have brought him pleasure instead of tormenting him. Also, I would like to vouch for ERP Therapy, as it literally saved my son's life. Four years ago his OCD was so severe he could not even eat. Today he is a college graduate, working, and living life to the fullest. I have become an advocate for OCD awareness, so thank you again for this educational article.

Dr. Williams,
Thank you so much for this enlightening article.
I also have a practice specializing in the treatment of OCD.
When you state that the worst kind of OCD is that of pedophile-OCD, you are not making an understatement.
The incredibly taboo nature of the obsession is a major hurdle for many OCD patients seeking therapy.
The shame aspect keeps too many people in a prison of the disorder for fear that sharing this fear with a clinician could result in misdiagnosis, misunderstanding, and misguided 'therapeutic interventions' that could result in the patient being delivered to a legal quagmire with family services involvement and the tangles thereof, when in fact, the individual is far from a pedophile. The OCD community and we that are the providers of treatment need more articles like yours bringing this information to the consciousness of the public.
Undoubtedly, there is someone suffering from this particular manifestation of OCD that has read your article and that can now possibly begin to take steps to getting the help that s/he needs to mange this debilitating diagnosis.
I appreciate your work in bringing this disorder the attention it has been sorely lacking.
Best,
Dr. Cynthia Giocomarra

Hello,
the beauty of online interventions is that the treatments are delivered via the internet.
Using the web as the vehicle for therapy allows a client in Sydney to connect with a specialist in another area.
The key component then for choosing to work with someone on this issue is not proximity and area, but rather resonance with the provider.
In my practice, clients are able to choose working with me because they feel I can help them, not that I am in the same city.
Maybe working with a distance-therapist on the internet is a possibility for yourself as well.
Wishing you Serenity and Well Being,
Dr. Cynthia Giocomarra
www.cynthiapsyd.com
1-888-906-8876

I am just so happy to think that someone has been cured of this. I have had this problem for 11 years, and am unable to function because of it, including having normal healthy relationships (friendships)

The most important thing in finding a competent therapist to treat OCD is they must be trained in Exposure and Response Prevention (ERP) therapy, the front line treatment for OCD. The IOCDF website, Beyond OCD, and my blog are all excellent resources to get you started on this search. Some therapists will say they use ERP but really don't understand it and all of the sites I mentioned give helpful questions for you to ask when you are seeking a healthcare professional. OCD is treatable, but sometimes finding the right provider is the hardest part of treatment! Unfortunately the wrong treatment provider and treatment often make OCD worse. Good luck as you move forward and please don't lose hope.

Hello,
Sometimes the degree which one holds is not necessarily indicative of "specialist" status, although the more training and schooling the better in my humble opinion.
As an expert in OCD holding a doctorate in psychology, as well as many years of experience working with this population, I have discovered the clients that enjoy the greatest amount of relief have been open to understanding WHY they are toiling under this problem as well as being willing to embrace the totality of the disorder.
Its a paradoxical intervention that I employ, but I have seen much success with the OCD sufferers with whom I work.
'Radical acceptance' of the disorder often provides a hugely significant amount of relief in and of itself.
Wishing you the best,
Dr. Cynthia Giocomarra

I have this problem. If it weren't for the internet I wouldn't have ever faced it. Thank you for the article. I wish there was more out there, though. But, alas, it was actually reaching out to 'real' people that had lasting help.
I'm not "cured" ... I got very angry when I read that "John" took so few sessions to move on. I've worked on this in therapy for a year or maybe a little more. I went most every week. Maybe my therapist could have used a different approach. I don't know. But it wasn't until after I attempted suicide and a psychiatrist told me straight up that I'm not a pedophile, that it's OCD, that I started to feel better. My treatment team started to tell me that they cared about me and that I'm really a good person. They shared their evidence for these opinions. This POCD crap made me feel so subhuman and worthless. I needed someone to show me the other side and tell me they didn't hate me for my thoughts. In the few articles I could find on POCD and Pure-O issues, the theories state that reassurance is a bad idea. I don't think so, at least not for everyone. I've had a few "OCD attacks" since the reassurance started but it's nothing compared to the constant torture that lasted a year or more. Perhaps the difference is the other symptoms I have. I don't have enough insight to speculate about why my recovery is different. Maybe it just took that safe feeling that I get from the connectedness of reaching out to let everything my therapist had been saying sink in. Everything makes so much more sense now.
I just think it might be wise to tell potential sufferers that may read this article that there are other ways to healing, too.

I can relate to John as well. I did and probably still have unpleasant thoughts about incest, homosexuality, pedophilia, murder, etc. But, I do not act on them. I am not letting those thoughts/worries define who I am.

I just thank God for allowing me to be raised by good parents and helping me distinguish right and wrong. I know that lusting or having sex with children, family members, those of the same sex, etc. is sinful.

If I did not know God and did not have my parents, I would probably be no different from an actual pedophile, murderer, sex offender, thief, or other creep.

I suffer much like your fathe did. I can't hug my sister, GFs daughter, any child without a sick and disgusting thought tormenting me. I am ashamed everyday for how I think. I've been tormented to the pint where I tell myself continuously that the only place for me is a jail cell. I even compare myself to serial pedophiles and think that I will be serving hard time like them someday. I live children. I have always wanted a son of my own but the older I get the worse it gets. It comes and goes in stages. I have also considered suicide thinking the world would be better off without me but I know I couldn't do it. I feel like I have shamed my family in skme way. When the thoughts are the worst, I avoid children like the plague. I can't even share a hug, kiss on the cheek, or even show affection to my little sister. I've suffered for many years and I don't know how much more I can take before I lose my mind. Sorry to ramble, but I feel your pain.

can anyone hlp me???i m suffring from worst kind of ocd...
i was very image councious ...for me reputation is must..so i maintaind my image as i wanted..bt slowly it turned into a fear..i started feeling like i m speaking sonething bad abt my self...nd so for saving my self from this fear..i started avoiding talks nd ppl...bt it was not enough..suddenly new fears realted my image started coming into my mind...today i m tottaly helpless..i dont know who am i..nd wht is my reality.i just wanna commint suicide bcz i cant take this pressure anymore..from last 6 years i m facing this fear...

I have been struggling with this problem just this week and the thoughts repulse me. I am going through an endless cycle of misery, where I continuously reassure myself that I am not that type of person but then a voice in the back in the back of my mind tells me I am...thus repeating the cycle with more reassurance.

I don't feel like I can put up with this too long but I have no idea to get past this. I don't want to live my life in a constant cycle of obsessively checking and reassuring myself and then checking and doubting.

I avoid children like the plague now and will avoid anything to do with children as they worry me and it triggers my worrying again. I reassure myself that my disgust and worry tells me that I am a good person but then I tell myself that just thinking those thoughts makes me a monster.... Please, help me :(

I know exactly how you feel. I'm a sex addict and have been able to get aroused by anything remotely sexual since I was four years old. It has led to some very shameful moments, including a time where I just thought for a fact I was a pedophile. It's odd, because I look at children and see nothing sexually arousing about them, but a voice tells me I must because of my past. It's very confusing and tormenting. If you'd like, we could exchange info and talk to each other.

I'm fifteen, female, and very recently had an unsolicited sexual thought about my little sister. I was helping her change, and things sort of degraded from there. I felt horrible later, writing that I felt maybe I needed to be seperated from my family and eventually started crying. It didn't happen again for a while,even when I was with them, but it happened again today- no tears, but certainly a spike in anxiety. Nothing too bad and not panic attack worthy, although it must have lasted a good 20 minutes. I unfortunately don't think that POCD is the answer, because I've also had incestuous thoughts about my older sibling that are not anxiety-inducing but frankly just annoying. I have had a mild case of trichotillomania for nearly 6 years now and have engaged in self-injurious behaviours but it has been almost a year since I last cut. I have not been to therapy. So I just want to know- could this possibly end up snowballing into something debilitating, or is it just a case of me being a teenager?

I realize that I may have been too ambiguous in my explanation and I would like to say that I have not touched my siblings inappropriately and I do not want to, or at least I think I do not want too. I'm just terrified because this is the type of thing that gets reported by a therapist, right? How in the world am I supposed to be able to look my mother in the eye if I am even allowed to stay with my family? This is the type of thing that gets people reported to the authorities and ruins their life and I'm just not equipped to deal with that. There was n article I read somewhere about a kid who told a therapist about something like this and BAM! Life ruined. So in the event that things get worse and I do seek out therapy, what sort of specialist should I look for so that they have seen this kind of thing?

I am sorry to hear about your struggles. I am Jasmine, Dr. Williams' office manager. We successfully treat people with your symptoms everyday, so there is hope!

Dr. Williams has a private practice with providers who work with people with these types of OCD.

I'm not sure where you are located, but she has an office in various states and we offer online treatment. Please call (860)830-7838 if you'd like to make an appointment or arrange a consultation. You can ask for Jasmine. You can also email me directly.

Thank you for the reply!
I apologize, but I am slightly confused as to the email portion. Is there a website or something where I find the email address? I apologize if this is a dumb question, but things have been worsening to the point where I spent near all of my free time today researching pedophilia and eventually panicked and reached out using another website's ask the therapist service but apparently my ask was to graphic so now I'm terrified and over here. I'd really like to get this treated before I end up too deep.